Tracheal intubation is an essential skill but can be difficult and may result in complications, the most serious being hypoxaemic brain damage and death. A significant lifting force, causing considerable tissue distortion but not damage, may be required in direct laryngoscopy. The Macintosh technique of laryngoscopy depends on indirect elevation of the epiglottis and is the most frequently used direct laryngoscopy technique in most centres. Direct laryngoscopy with the straight laryngoscope was the first technique to allow tracheal intubation under vision. The straight laryngoscope offers unique advantages and there is good evidence of its value. The laryngoscope is inserted to the right of the midline and passed along the paraglossal gutter to the right side of the tongue. Many alternative techniques can facilitate tracheal intubation under vision in patients in whom this is not possible with direct laryngoscopy. Nasotracheal intubation is necessary when the oral route is not available.